Relationship between combined systemic inflammatory indices with presence and severity of hyperemesis gravidarum.

OBJECTIVE: Our study aims to determine the levels of systemic inflammation markers and the combined systemic inflammation indices in hyperemesis gravidarum (HG) patients and to investigate the association between the severity of the disease. PATIENTS AND METHODS: The study population consisted of 83 pregnant women with HG and 100 healthy pregnant women matched for gestational age as a control group. We grouped the HG patients according to the Modified Pregnancy Unique Quantification of Emesis/Nausea (PUQE) scoring system as mild, moderate, and severe. We calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), MPV-to-lymphocyte ratio (MPVLR), RDW-to-platelet ratio (RPR), Systemic immune-inflammation index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Systemic Inflammation Index (AISI). RESULTS: NLR, PLR, SII, SIRI, and AISI levels were significantly higher in the HG group. These indices tended to increase as the severity of the disease increased. We found NLR, PLR, SII, SIRI, and AISI indices as the independent risk factors for the presence and severity of HG. The SIRI index, which has the highest area under the curve (AUC), sensitivity, and specificity values, was determined as the most powerful diagnostic tool in the diagnostic evaluation of the presence (AUC: 0.695; p < 0.001; sensitivity: 54%; specificity: 75%; cut-off: 3.14) and severity (AUC: 0.785; p < 0.001, sensitivity: 82%; specificity: 68%; cut-off: 2.74) of HG. CONCLUSIONS: Our study results showed that combined systemic inflammatory indices (NLR, PLR, SII, SIRI, and AISI) are associated and correlated with the presence and severity of HG. These indices are independent risk factors for the presence and severity of HG. Combined systemic inflammatory indices are diagnostic in determining the severity of HG. The SIRI index has the best diagnostic power for both the diagnosis of HG and the determination of the severity of HG.

Therapeutic effect of 6-shogaol on acetaminophen-induced hepatotoxicity in mice: an experimental study.

OBJECTIVE: Acetaminophen (APAP) is one of the most commonly used analgesics and antipyretics. It causes serious liver damage when taken in large quantities by adults or children. Also, 6-shogaol is an active compound obtained from ginger with anti-inflammatory and antioxidant properties. This study aimed at examining the therapeutic effect of 6-shogaol in APAP-induced hepatotoxicity. MATERIALS AND METHODS: The mice were separated into five groups. After the mice were sacrificed, the levels of alanine aminotransferase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) in the blood, glutathione (GSH) level in the liver tissue homogenate, and levels of induced nitrite oxide synthetase (INOS) and total nitrite/nitrate were measured by spectrophotometric methods. RESULTS: APAP administration significantly increased the serum levels of ALT, AST, and ALP, INOS activity in liver tissue, and total nitrite/nitrate levels compared with control and significantly decreased GSH levels. After APAP toxicity, 6-shogaol and N-acetylcysteine (NAC) administration significantly decreased the levels of ALT, AST, INOS, and total nitrite/nitrate levels and significantly increased GSH levels compared with control. Also, 6-shogaol was found to be better than NAC in increasing the GSH level. CONCLUSIONS: The study showed that 6-shogaol might have an early therapeutic effect on APAP-induced liver damage.

Assessment of serum glucose/potassium ratio as a predictor for delayed neuropsychiatric syndrome of carbon monoxide poisoning.

INTRODUCTION: Carbon monoxide (CO) poisoning is a crucial cause of delayed neuropsychiatric syndrome (DNS). However, most biomarkers are not satisfactory for the prediction of DNS caused by CO poisoning. Thus, we evaluated the adequacy of the serum glucose/potassium (GLU/K) ratio, which may be an easy, quick, and readily available parameter that can be used in the emergency department for predicting DNS. METHODS: We evaluated 281 patients who were admitted to our emergency department between January 2012 and December 2018. The patients were divided into two groups: DNS (+) and DNS (-). The GLU/K was compared for the groups. RESULTS: Glucose, blood urea nitrogen, carboxyhemoglobin, and GLU/K ratios of patients in the DNS (+) group were statistically significantly higher than those patients in DNS (-) group (140 ± 34 vs. 110 ± 24, p < 0.001; 17.58 ± 6.14 vs. 14.27 ± 5.08, p = 0.003; 29 ± 5.1 vs. 18.9 ± 7.6, p < 0.001; and 38.35 ± 10.11 vs. 28.65 ± 6.53, p < 0.001, respectively). The area under the curve for GLU/K to predict DNS was measured as 0.791, and 35.9 as a cut-off value had 63.6% sensitivity and 89.6% specificity. CONCLUSIONS: DNS development in CO poisoning is a serious and feared complication. We suggest that the GLU/K ratio has a high potential as a rapid, easy preliminary marker for the exclusion of patients who will not subsequently develop DNS.

Serum YKL-40 levels as a novel marker of inflammation in patients with endometriosis.

PURPOSE: To establish serum YKL-40 concentrations in patients with endometriosis compared to age-matched healthy subjects. MATERIALS AND METHODS: This was a cross-sectional clinical study conducted in a tertiary care center. Demographics and serum YKL levels were determined and noted in a total of 63 cases (33 endometriosis patients, 30 healthy controls). Measurement of YKL-40 levels was made using a YKL-40 enzyme-linked immunosorbent assay (ELISA) kit according to the manufacturer's protocol. RESULTS: The mean serum YKL-40 levels of the patient group was 106.0 +/- 15.9 (range 23.44 to 382.55) years, while the mean serum YKL-40 levels of the controls was 52.2 +/- 7.0 (range 22.35 to 160.0) years (p = 0.003). CONCLUSIONS: This is the first study evaluating serum YKL-40 levels in endometriosis. The present results indicate that YKL-40 levels were increased in patients with endometriosis compared to controls. The authors propose that circulating YKL-40 levels could be a novel biomarker for diagnosis and follow-up of endometriosis.

Is there relationship between social support, psychological distress, mood disorders and emesis gravidarum?

OBJECTIVE: Emesis Gravidarum (EG) is common medical condition in pregnancy with significant negatively effects on daily social life, physical and psychological health. In this study, relationship of social support, psychological distress and mood disorders on EG were investigated. METHODS: The pregnant women with mild EG were accepted as control group and moderate and severe EG were accepted as patient group. All patients completed sociodemographic data collection form, Pregnancy-Unique Quantification of Emesis and Nausea scale (PUQE-24), Symptom Check List questionnaire (SCL-90 R), Spielberger state-trait anxiety inventory (STAI), Beck depression inventory (BDI) and Multidimensional Scale of Perceived Social Support (MSPSS). STAI, BDI, MSPSS and GSI (global symptom index) scores of the patients and control groups were compared. RESULTS: Statistically significant differences were found between the patients and control group on STAI score, BDI score and GSI scores. No statistically significant were found between the patients and control group on MSPSS score. CONCLUSION: Social support does not prevent patients from EG. But, there is a clear relationship between EG and psychological distress. Thus, psychiatric evaluation should be done in patients with EG. Obstetricians should encourage their patients to have psychiatric support. Further studies on relationship of psychosocial factors and EG are needed.

The impact of the time interval on in-vitro fertilisation success after failure of the first attempt.

The aim of this study was to identify the optimal time interval for in-vitro fertilisation that would increase treatment success after failure of the first attempt. This retrospective study evaluated 454 consecutive cycles of 227 infertile women who had two consecutive attempts within a 6-month period at an IVF centre. Data were collected on duration of stimulation, consumption of gonadotropin, numbers of retrieved oocytes, mature oocytes, fertilised eggs, good quality embryos on day 3/5 following oocyte retrieval and clinical and ongoing pregnancy. There were significant increases in clinical pregnancy rates at 2-, 3- and 4-month intervals. The maximum increase was after two menstrual cycles (p = 0.001). The highest rate of ongoing pregnancy was in women that had the second attempt after the next menstrual cycle following failure of IVF (27.2%). After IVF failure, initiating the next attempt within 2-4 months increases the clinical pregnancy rates.

Evaluation of quality of life in fertile Turkish women with severe endometriosis.

We assessed the impact of pain, dysmenorrhoea and dyspareunia on the quality of life among Turkish fertile women with severe endometriosis. A total of 33 patients with histopathologically diagnosed severe endometriosis (Stage IV, revised criteria of the American Fertility Society (rAFS score) were enrolled into the study. Patients reported chronic pelvic pain using a visual analogue scale (VAS) and severity of dysmenorrhoea, dyspareunia and pelvic tenderness using the verbal rating scale (VRS). Quality of life (physical, psychological, social, environmental domains) was evaluated using the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF). There were no correlations between quality of life and VRS and VAS scores of chronic pelvic pain in patients with dyspareunia (p > 0.05). VRS in patients with dysmenorrhoea negatively correlated with physical, social and environmental dimensions of quality of life (r = -0.382, r = -0.221, r = -0.373 and p = 0.028, p = 0.013, p = 0.033, respectively). Although the severity of dysmenorrhoea seems to be related with lower quality of life, chronic pelvic pain and dyspareunia due to endometriosis may not have any deleterious effects on the quality of life.

Is induction of labour by Propess(®) safe? A comparison of midwife-led versus obstetrician-led labour management.

This retrospective study compared maternal and fetal outcomes after labour induction, using a dinoprostone vaginal pessary (Propess(®)) in midwife-led and obstetrician-led labour management. Labour induction outcomes, delivery mode and rates of admission to the neonatal intensive care unit were compared. A total of 405 women, 40.5% (n = 164) from midwife-led units and 59.5% (n = 241) from an obstetrician-led unit, participated. There was no statistically significant difference between the two groups in caesarean section rate or neonatal intensive care unit admission rates (p = 0.789 and 0.769, respectively). Non-reassuring fetal non-stress test and uterine hyperstimulation risks were higher in the obstetrician-led unit (p = 0.003 and 0.001, respectively, and odds ratio (OR) 0.165, 95% CI: 0.117-0.232 and OR 0.218, 95% CI: 0.078-0.611, respectively). Postpartum blood transfusion rate was higher in the midwife-led units (p = 0.002, OR 8.082, 95% CI: 1.879-39.292). Labour induction with Propess(®) is safe during both midwife-led and obstetrician-led labour management.

Gingival crevicular fluid levels of human beta-defensin-2 and cathelicidin in smoker and non-smoker patients: a cross-sectional study.

BACKGROUND AND OBJECTIVE: Cathelicidin (LL-37) and human ß-defensin-2 (hBD-2) are antimicrobial peptides that have additional functions in innate immunity. The purpose of this study was to evaluate LL-37 and hBD-2 levels in the following patient groups: non-smoker patients with gingivitis (G), smoker patients with gingivitis (SG), non-smoker patients with generalized aggressive periodontitis (AgP) and smoker patients with generalized aggressive periodontitis (SAgP). MATERIAL AND METHODS: A total of 80 patients, including 20 G, 20 SG, 20 AgP and 20 SAgP were enrolled in the study. Clinical periodontal parameters, including periodontal status were assessed by measuring bleeding on probing, plaque index, gingival index, probing depth and clinical attachment loss. Enzyme-linked immunosorbent assays were done to quantify LL-37 and hBD-2 levels in gingival crevicular fluid. RESULTS: Clinical periodontal parameters were found to have no statistically significant differences between the SAgP and AgP groups or between the SG and G groups. LL-37 and hBD-2 levels were significantly lower in G patients than in other groups. LL-37 and hBD-2 levels in the gingival crevicular fluid of SAgP patients were significantly higher than in other groups. LL-37 and hBD-2 levels in SG patients were also significantly higher than in G patients. CONCLUSIONS: Epithelial cells in contact with microorganisms release LL-37 and hBD-2 to eliminate them. The release response of LL-37 and hBD-2 formed against microorganisms can change depending on factors such as smoking, which activates the nicotinic receptors present on epithelial surfaces. This interaction can increase the release of LL-37 and hBD-2. Smoking may also affect the capillary tissues and reduce leukocytic chemotaxis. The increased number of colonized microorganisms may lead to higher levels of LL-37 and hBD-2 release in the tissues of smokers than in non-smokers.

Comparison of peri-implant crevicular fluid levels of adrenomedullin and human beta defensins 1 and 2 from mandibular implants with different implant stability quotient levels in nonsmoker patients.

BACKGROUND AND OBJECTIVE: To achieve satisfactory osseointegration, primary stability and healthy peri-implant tissue must be available. In this study, our objective was to compare the adrenomedullin, human beta-defensin (hBD)-1 and hBD-2 levels in implants with different implant stability quotient (ISQ) values and with different peri-implant tissue health values in the peri-implant crevicular fluid. MATERIAL AND METHODS: Thirty patients with 60 endosseous osseointegrated implants were included in this study. Following the completion of the osseointegration process, these implants were divided into two main groups: a group of 15 implants with peri-implantitis (peri-implantitis: 40 ≤ ISQ ≤ 80 peri-implantitis, n = 15) and a group of 45 implants with healthy peri-implant tissue. The healthy peri-implant tissue group was further divided into three subgroups according to their ISQ values (Healthy-60: 60 ≤ ISQ ≤ 70, healthy peri-implant, n = 15; Healthy-80: 71 ≤ ISQ ≤ 80, healthy peri-implant, n = 15; and Healthy-100: 81 ≤ ISQ ≤ 100, healthy peri-implant, n = 15). The levels of adrenomedullin, hBD-1 and hBD-2 in the peri-implant crevicular fluid were assessed using ELISAs. RESULTS: When the peri-implant clinical measurements were compared within groups, they were found to be highest in the peri-implantitis group and lowest in the Healthy-100 group. The adrenomedullin, hBD-1 and hBD-2 levels in the peri-implant crevicular fluid of the peri-implantitis group were found to be significantly higher than those in the Healthy-60, Healthy-80 and Healthy-100 groups. When only the healthy peri-implant tissue groups were evaluated, the adrenomedullin, hBD-1 and hBD-2 levels in the peri-implant crevicular fluid of the Healthy-60 group were found to be significantly higher than those in the Healthy-80 and Healthy-100 groups. The lowest adrenomedullin, hBD-1 and hBD-2 levels were observed in the Healthy-100 group. CONCLUSION: In cases of peri-implantitis, higher adrenomedullin, hBD-1 and hBD-2 levels were observed. These results indicate the presence of a tissue response to prevent the creation of a pathological environment in the peri-implant tissue. In groups with healthy peri-implant tissues, the ISQ value decreases as the adrenomedullin, hBD-1 and hBD-2 levels increase. This condition is thought to be caused by increased dental plaque accumulation and bone resorption in addition to increased lateral implant movements and colonization of microorganisms in the microcavities between the implant elements.

Gingival crevicular fluid levels of human beta-defensins 1 and 3 in subjects with periodontitis and/or type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND AND OBJECTIVE: Human ß-defensins (hBDs) have a strong antibacterial action against various microorganisms, especially periodontal pathogens. The aim of this study was to compare the total levels of hBD-1 and hBD-3 in the gingival crevicular fluid of healthy patients with gingivitis (HG), healthy patients with chronic periodontitis (HP), patients with type 2 diabetes mellitus (DM) and gingivitis (DM2G) and patients with type 2 DM and chronic periodontitis (DM2P). MATERIAL AND METHODS: A total of 80 patients were included: 20 HG, 20 HP, 20 DM2G and 20 DM2P. The levels of hBD-1 and hBD-3 in gingival crevicular fluid were measured using ELISA. RESULTS: The DM2P group had significantly higher periodontal clinical parameters at sites from which gingival crevicular fluid was collected compared with the other groups. The HG group had significantly lower periodontal clinical parameters within the gingival crevicular fluid-collected sites than did the HP, DM2G and DM2P groups. The gingival crevicular fluid of the DM2P group had significantly higher levels of total hBD-1 and hBD-3 than did that of the other groups; the hBD-1 and hBD-3 levels were significantly higher in the gingival crevicular fluid of the DM2G group than in that of the the non-DM type 2 groups (HG and HP). The gingival crevicular fluid of the HP group had significantly higher levels of total hBD-1 and hBD-3 in comparison with that of the HG group. CONCLUSION: As a result of the observed vascular and cell activity changes that occur within patients diagnosed with DM, periodontal diseases become more severe. These changes hinder the migration and the ability of chemotactic factors and leukocytes to protect periodontal tissues from the effects of microorganisms. In order to eliminate microorganisms, the epithelial cells in patients with DM may release more hBD-1 and hBD-3 into the gingival crevicular fluid. Determining the amount of hBD-1 and hBD-3 in the gingival crevicular fluid of patients with and without DM will help to elucidate the relationship among hBD-1, hBD-3, DM and periodontal disease.

The role of nitric oxide in testicular ischemia-reperfusion injury.

PURPOSE: This study was designed to determine the role of nitric oxide (NO) in the ischemia-reperfusion (I/R) injury process in testes. METHODS: Fifty prepubertal male rats were divided into 5 groups each containing 10 rats. After 4-hour torsion and 4-hour detorsion, bilateral orchiectomies were performed for measurement of tissue malondialdehyde (MDA) level and histopathologic examination. The results were compared statistically. The groups were labeled as group 1, basal values of biochemical parameters in testes; group 2 (control group), torsion plus detorsion; group 3, torsion plus N-monomethyl-L-arginine (L-NMMA) plus detorsion; group 4, torsion plus L-arginine plus detorsion; group 5, sham operation. RESULTS: The highest MDA values were determined in the L-arginin group in ipsilateral testes. Group 3 and group 4 were statistically different from control group. Histological examination showed that specimens from group 4 had a significantly (P < .05) greater histological injury than group 3, and contralateral testes showed normal testicular architecture in all groups. CONCLUSIONS: These results suggest that NO plays an important role in damaging the testis with I/R. Although inhibition of NO synthesis with L-NMMA significantly improves I/R injury in testes, enhancing NO production by providing excess of L-arginine increases such damage. In the early periods of detorsion, there is no damage to contralateral testes after unilateral testicular torsion.